Value of dual-layer detector spectral CT quantitative parameters in evaluating treatment response of neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer
Value of dual-layer detector spectral CT quantitative parameters in evaluating treatment response of neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer
袁文静 1黄芷晴 1贾子琪 1张汉良 1卢健烨 1杜晓华 2温志波 3刘岘 1陈维翠 1胡凌
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作者信息
1. 广东省中医院 广州中医药大学第二附属医院放射科，广州 510120
2. 广东省中医院 广州中医药大学第二附属医院病理科，广州 510120
3. 南方医科大学珠江医院影像科，广州 510145
折叠
摘要
目的 探讨双层探测器光谱CT定量参数评估局部进展期直肠癌（LARC）患者对新辅助放化疗（nCRT）治疗反应的价值。 方法 本研究为横断面研究，回顾性收集2021年5月至2023年3月广东省中医院接受完整nCRT且经病理证实为直肠腺癌的52例LARC患者，于nCRT前、后分别行光谱CT平扫、动脉期（AP）及静脉期（VP）扫描。根据肿瘤退缩分级标准，将患者分为反应良好组（n=20）及反应不良组（n=32）。测量nCRT前、后肿瘤平扫图像的有效原子序数（Zeff）、AP和VP碘浓度（IC）和40、100 keV虚拟单能量图的CT值，计算nCRT前、后AP和VP标准化碘浓度值（NIC）、光谱曲线斜率（λHU）及上述参数治疗前后的变化率。采用独立样本t检验或Mann-Whitney U检验比较2组患者各定量参数的差异，采用受试者操作特征（ROC）曲线计算各参数评估肿瘤nCRT后反应的效能。选择曲线下面积（AUC）>0.75的参数采用二元logistic回归建立联合参数，并评价其效能。 结果 反应良好组与反应不良组患者间nCRT前NICAP、λHUVP，nCRT后NICVP、λHUVP以及Zeff、NICAP、NICVP、λHUAP变化率差异有统计学意义（P均<0.05），其余参数差异无统计学意义（P均>0.05）。ROC曲线结果显示，上述8个参数评估肿瘤nCRT后反应的AUC分别为0.702、0.655、0.695、0.769、0.738、0.807、0.791和0.677。将AUC>0.75的3个参数（nCRT后λHUVP、NICAP变化率、NICVP变化率）组成联合参数，其AUC值为0.869，灵敏度为80.0%，特异度为84.4%。 结论 光谱CT定量参数在评估LARC患者对nCRT治疗反应具有应用价值，多参数联合可提高诊断效能。 Objective To explore the value of dual-layer detector spectral CT quantitative parameters in evaluating the treatment response of neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer (LARC). Methods The study was a cross-sectional study. From May 2021 to March 2023, a total of 52 patients with LARC who received complete nCRT and were pathologically confirmed rectal adenocarcinoma at the Guangdong Province Hospital of Traditional Chinese Medicine were retrospectively enrolled. Each patient underwent spectral CT examination before and after nCRT, including plain scan, arterial phase (AP), and venous phase (VP) scans. According to the tumor regression grade, the patients were divided into the good response (n=20) and the poor response group (n=32). Measurements of the primary tumor′s spectral CT parameters, including effective atomic number (Zeff) at plain scan, iodine concentration (IC), CT values of 40 keV and 100 keV virtual monochromatic image (VMI) at dual-enhanced phases, were taken before and after nCRT. Additionally, the normalized iodine concentration (NIC), spectral curve slope (λHU), and the change rate of the above parameters before and after nCRT were calculated. The independent sample t-test or Mann-Whitney U test was used to compare the differences between the two groups. The receiver operating characteristic (ROC) curve was used to assess the efficacy of various metrics in evaluating the tumor treatment response of nCRT. A binary logistic regression analysis of combined parameter results was performed for the parameters with the areas under curve (AUC)>0.75, and the AUC of the combined parameter was evaluated. Results There were significant differences in NICAP and λHUVP before nCRT, NICVP and λHUVP after nCRT, and the change rates of Zeff, NICAP, NICVP and λHUAP between the good response group and the poor response group (P<0.05). The remaining parameters showed no statistically significant difference (P>0.05). The ROC curve results showed that the AUCs of the above 8 parameters for evaluating tumor treatment response of nCRT were 0.702, 0.655, 0.695, 0.769, 0.738, 0.807, 0.791, and 0.677, respectively. The AUC of the combined model of the three parameters with AUC>0.75 (λHUVP after nCRT, the change rate of NICAP and NICVP) was 0.869, with 80.0% sensitivity and 84.4% specificity. Conclusion The quantitative parameters derived from spectral CT may provide new markers for evaluating the response to nCRT treatment in patients with LARC. The multi-parameter combined model can improve diagnostic efficacy.
Abstract
Objective To explore the value of dual-layer detector spectral CT quantitative parameters in evaluating the treatment response of neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer (LARC). Methods The study was a cross-sectional study. From May 2021 to March 2023, a total of 52 patients with LARC who received complete nCRT and were pathologically confirmed rectal adenocarcinoma at the Guangdong Province Hospital of Traditional Chinese Medicine were retrospectively enrolled. Each patient underwent spectral CT examination before and after nCRT, including plain scan, arterial phase (AP), and venous phase (VP) scans. According to the tumor regression grade, the patients were divided into the good response (n=20) and the poor response group (n=32). Measurements of the primary tumor′s spectral CT parameters, including effective atomic number (Zeff) at plain scan, iodine concentration (IC), CT values of 40 keV and 100 keV virtual monochromatic image (VMI) at dual-enhanced phases, were taken before and after nCRT. Additionally, the normalized iodine concentration (NIC), spectral curve slope (λHU), and the change rate of the above parameters before and after nCRT were calculated. The independent sample t-test or Mann-Whitney U test was used to compare the differences between the two groups. The receiver operating characteristic (ROC) curve was used to assess the efficacy of various metrics in evaluating the tumor treatment response of nCRT. A binary logistic regression analysis of combined parameter results was performed for the parameters with the areas under curve (AUC)>0.75, and the AUC of the combined parameter was evaluated. Results There were significant differences in NICAP and λHUVP before nCRT, NICVP and λHUVP after nCRT, and the change rates of Zeff, NICAP, NICVP and λHUAP between the good response group and the poor response group (P<0.05). The remaining parameters showed no statistically significant difference (P>0.05). The ROC curve results showed that the AUCs of the above 8 parameters for evaluating tumor treatment response of nCRT were 0.702, 0.655, 0.695, 0.769, 0.738, 0.807, 0.791, and 0.677, respectively. The AUC of the combined model of the three parameters with AUC>0.75 (λHUVP after nCRT, the change rate of NICAP and NICVP) was 0.869, with 80.0% sensitivity and 84.4% specificity. Conclusion The quantitative parameters derived from spectral CT may provide new markers for evaluating the response to nCRT treatment in patients with LARC. The multi-parameter combined model can improve diagnostic efficacy.
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